Workplace Positive Drug Tests Reach New High

Positivity rates for employment drug testing reached a 16-year high in 2019, according to recent data collected and reported by Quest Diagnostics[1]. The overall positivity rate in the combined U.S. workforce increased to 4.5%, the highest level recorded since 2003, and is 28% higher than the 30-year low of 3.5% (2010-2012).  With more than 18 million urine drug test results analyzed in the Quest Diagnostics Drug Testing Index[2], and to no surprise, marijuana positives continue to lead the way (11%). However, the data shows concerning increases in cocaine and methamphetamine positives.

Positivity Rates for Cocaine and Methamphetamine

Cocaine positivity in the general U.S. workforce testing increased in the Midwest and West regions over the past five years. Cocaine positivity in the Midwest increased by 40% and in the West by 53%. The Midwest was 20% less than the national rate in 2015 but 3.7% above the national rate in 2019, suggesting a surge in positivity in the region last year. 

The Midwest region experienced year-over-year increases, driven primarily by double-digit increases in the East North Central region during this period. Over the past five years, methamphetamine positivity in the Midwest increased by nearly 78%.

“While the national debate on drug misuse in the workforce has focused primarily on marijuana, increasing positivity rates for cocaine and methamphetamine are also cause for concern,” said Dr. Barry Sample, Senior Director of Science and Technology for Quest. Positivity by drug and region can be random and unpredictable. Our data is a reminder that it is important to remain vigilant about all drug misuse in the workforce.” 

Opiates and COVID-19

A silver lining in the data shows that the positivity rates within the general U.S. workforce for opiates in urine drug testing continues to decline across all opiate categories. Positivity rates for opiates (primarily codeine and morphine) dropped more than 19% from 2018. Positivity rates for semi-synthetic opiates (hydromorphone and hydromorphone) decreased 26% over the last year. Oxycodone positives declined 21% from 2018 and are down almost 55% compared to data from 2015.

With social isolation, stress, and the uncertainly driven from the COVID-19  pandemic, there is still a significant cause for concern with Americans ‘self-medicating’ and for those currently battling a substance abuse addiction who have a substantial risk of relapsing during these times. Drug deaths in the United States rose 5% in 2019 following a decline in 2018, mainly driven by methamphetamine, cocaine, and fentanyl. During the first few months of 2020, drug deaths increased around 13% compared with 2019, attributable partly to disruptions caused by COVID-19.

“There is no question that before COVID-19, rates of workplace drug positivity were trending in the wrong direction, based on our data,” Dr. Sample says. “The enormous strain caused by COVID-19 may prove to be an accelerant on this disturbing trend. Organizations will need to consider the impact of COVID-19 not only on workplace safety but also as a health concern for their employees for some time to come.”

For an interactive map with positivity rates and trend lines by three-digit zip code in the United States, visit[3].

Employer Actions

The data continues to affirm the need for comprehensive workplace substance abuse screening programs. While conducting a drug test as a condition of hire continues to be the most common time to evaluate potential employee’s drug use, most positive drug tests are found during reasonable suspicion and post-accident drug testing situations. Employers should take this opportunity to assess their substance abuse screening program to ensure they are prepared for today’s use trends, both pre-hire and, more importantly, post-hire to minimize drug use in the workplace. 

Employers not conducting post-employment drug testing should seriously reevaluate the opportunity to evolve their screening program. Employers are also strongly encouraged to ensure their supervisors and managers are adequately trained to recognize the signs and symptoms of drug use in the workplace, along with the appropriate steps to take in reasonable suspicion situations to avoid any mistakes during the ‘heat of the moment.’